Association of neuroimaging markers with clinical and neuropsychological profiles in pediatric ADHD: A cross-sectional study.

BACKGROUND

Glymphatic-related perivascular processes may influence neurodevelopment, but their role in ADHD remains unclear. This study offers the first integrated assessment of glymphatic MRI markers in pediatric ADHD.

METHODS

In this cross-sectional case-control study, children with ADHD (n = 80) and age-matched controls (n = 110) underwent multimodal MRI. Structural glymphatic integrity was measured using the diffusion-derived ALPS index and choroid plexus volume from T1 segmentation, while functional dynamics were assessed via gBOLD-CSF coupling from resting-state fMRI. Cognitive performance and symptom severity were evaluated with standardized neuropsychological and behavioral tests.

RESULTS

Children with ADHD showed markedly higher ADHD-RS-IV, anxiety, and depressive symptoms (all P < 0.001). ALPS indices were significantly reduced (1.42 ± 0.18 vs. 1.51 ± 0.17; P = 0.002). CPV exhibited a non-significant trend toward enlargement (P = 0.060), whereas gBOLD-CSF coupling did not differ between groups (P = 0.635). Higher ALPS values correlated with better long-delay recall, recognition and processing speed (all P ≤ 0.006) and fewer inattentive symptoms and lower anxiety (P ≤ 0.020).

CONCLUSION

ADHD in children shows mild structural glymphatic alterations, with reduced ALPS linked to deficits in attention and cognition, indicating a potential neurodevelopmental role of perivascular pathways.